![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 17 to 41 of 135. Go back in thread:
Posted by med_empowered on January 6, 2007, at 11:50:21
In reply to Re: Patient paid to accept neuroleptic depot injec, posted by SLS on January 6, 2007, at 11:32:36
the studies are WHO studies...there were 2 of them, and I think the last one was done in the early 1990s. All the patients were DX'd by the same criteria--I think it was the ICD-10 definition of schizophrenia, not the DSM-IV--and followed up for a number of years. Apparently, in less developed countries, fewer patients were ever placed on neuroleptics, and very few were maintained on neuroleptics. Wealthy countries had low success rates in schizophrenia, as measured by continuing symptoms and more important things, like jobs and social integration. Poorer countries did much better in terms of relapse, social integration, and severity over the course of the study.
Since the countries involved had widely different cultures, I think the low use of neuroleptics has to be considered a possible factor. I think arguing that there was a problem in diagnosis reflects an unwillingness to find out what's going on here. The diagnostic criteria applied was quite sound and was applied uniformly; I think the problem is that in much of the world, schizophrenia is considered to have a very poor prognosis, so if a patient (or large group of patients) end up doing well, then the assumption is "well, it wasn't schizophrenia, after all". That is circular logic at its worst.
Apparently, there were studies early on in the days of neuroleptics that tended to show longer hospitalization times and more social dependency (welfare, etc.) in patients treated with and maintained on neuroleptics than with patients treated with non-neuroleptic methods (mainly psychosocial intervention). Also, Courtenay Hardening did a study in the 80s in which she tracked down patients (many backwards) who had been treated w/ psychosocial programs. Surprisinly, LOTS of them recovered fully or to a meaningful extent, and the ones who either stopped neuroleptics or never took them were among the best cases. Also, there was subgroup of patients who took very low doses of neuroleptics only when necessary, and they were also doing quite well.
Plus, there are shrinks now who are calling for looking at schizophrenia as a variant of bipolar, and using anticonvulsants and lithium in place of the neuroleptics. Some studies have also shown positive effects from high-dose diazepam and propranolol therapies.
Also, over the course of the illness, neuroleptics increase mortality. They increase seizures, obesity, liver problems, heart problems, and sudden deaths. Compared to patients not treated with neuroleptics, there may also be an increase in suicides, even with the atypicals. (Although clozapine is claimed to reduce suicide--I don't know if this is compared to older antipsychotics or to untreated schizophrenia, though).
Posted by linkadge on January 6, 2007, at 11:58:41
In reply to Re: Patient paid to accept neuroleptic depot injec, posted by SLS on January 6, 2007, at 11:32:36
I don't know if one could assume that the rate of prescription of neuroleptic medications would be less in developing countries?
I think med empowered knows more about this information. I originally heard the point originally discussed by him/her.
Simpler socities perhaps, less information overload, less to be paranoid about. (I don't know if that would hold any water though).Vitamin D status of mothers might be higher in developing countries.
I just don't know what kind of information exists that says that neuroleptics imrpove the *long term* outcome of schizophrenia. They certainly aren't correcting the underlying disturbance.
Linkadge
Posted by Klavot on January 6, 2007, at 12:13:29
In reply to Re: Patient paid to accept neuroleptic depot injec, posted by SLS on January 6, 2007, at 11:32:36
> > Cohen:
> >
> > "Studies have shown that the outcome of schizophrenia is better in developing countries [10–12], and therefore the point prevalence in these countries should be lower. Despite this clear difference in the course of schizophrenia..."
> >
> > http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1140960#pmed-0020151-b10
> >
> > These statements don't make sense to me. I wonder what exactly is being diagnosed.
>
>
> The one thing missing from the things I have read: Nowhere is there a statement indicating that the patients were not treated with neuroleptics.
>
>
> - ScottAnother important consideration: In developing countries, there is probably greater use of older, cheaper, typical antipsychotics, while in developed countries, there is probably greater use of more expensive, atypical antipsychotics. So in that sense, we are not even dealing with the same treatments for developing vs. developed countries.
Where I live (South Africa), drugs like Zyprexa are not available in state hospitals because it is too expensive. They only use drugs like chlorpromazine. Even drugs like Zoloft are not used in state psychiatric facilities - they use tricyclics, because it is cheaper.
Klavot
Posted by fca on January 6, 2007, at 12:30:59
In reply to Re: Patient paid to accept neuroleptic depot injec, posted by Klavot on January 6, 2007, at 12:13:29
It seems to me that if you truly believe in patient choice and the right to refuse treatment ( sans dangerous to self or others)one is hard pressed to think that one can not choose treatment with compensation. If you can choose no treatment with the very real risk of negative and/or positive consequences why can one not choose treatment with compensation even though there might be positive and/or negative consequences. If one is resistant to taking medication because of a fear of negative consequences why is it any less a matter of autonomy to choose compensation even if other negative consequences may be experienced. Thanks fca
Posted by SLS on January 6, 2007, at 13:07:25
In reply to the case for neuroleptics is kind of weak, posted by med_empowered on January 6, 2007, at 11:50:21
Good post, M_E.
There are a few things that I would like to address, but I gotta run.
One thing that strikes me as funny, though, is that a statement like this: "I think arguing that there was a problem in diagnosis reflects an unwillingness to find out what's going on here." is so quickly made in a forum where so many people berate the ability of psychiatrists to properly diagnose patients - or even if there is really anything consistently reliable to diagnosis at all.
As you said, I do think something is wrong here, and I would like to know what it is.
- Scott
> the studies are WHO studies...there were 2 of them, and I think the last one was done in the early 1990s. All the patients were DX'd by the same criteria--I think it was the ICD-10 definition of schizophrenia, not the DSM-IV--and followed up for a number of years. Apparently, in less developed countries, fewer patients were ever placed on neuroleptics, and very few were maintained on neuroleptics. Wealthy countries had low success rates in schizophrenia, as measured by continuing symptoms and more important things, like jobs and social integration. Poorer countries did much better in terms of relapse, social integration, and severity over the course of the study.
>
> Since the countries involved had widely different cultures, I think the low use of neuroleptics has to be considered a possible factor. I think arguing that there was a problem in diagnosis reflects an unwillingness to find out what's going on here. The diagnostic criteria applied was quite sound and was applied uniformly; I think the problem is that in much of the world, schizophrenia is considered to have a very poor prognosis, so if a patient (or large group of patients) end up doing well, then the assumption is "well, it wasn't schizophrenia, after all". That is circular logic at its worst.
>
> Apparently, there were studies early on in the days of neuroleptics that tended to show longer hospitalization times and more social dependency (welfare, etc.) in patients treated with and maintained on neuroleptics than with patients treated with non-neuroleptic methods (mainly psychosocial intervention). Also, Courtenay Hardening did a study in the 80s in which she tracked down patients (many backwards) who had been treated w/ psychosocial programs. Surprisinly, LOTS of them recovered fully or to a meaningful extent, and the ones who either stopped neuroleptics or never took them were among the best cases. Also, there was subgroup of patients who took very low doses of neuroleptics only when necessary, and they were also doing quite well.
>
> Plus, there are shrinks now who are calling for looking at schizophrenia as a variant of bipolar, and using anticonvulsants and lithium in place of the neuroleptics. Some studies have also shown positive effects from high-dose diazepam and propranolol therapies.
>
> Also, over the course of the illness, neuroleptics increase mortality. They increase seizures, obesity, liver problems, heart problems, and sudden deaths. Compared to patients not treated with neuroleptics, there may also be an increase in suicides, even with the atypicals. (Although clozapine is claimed to reduce suicide--I don't know if this is compared to older antipsychotics or to untreated schizophrenia, though).
>
>
Posted by ed_uk on January 6, 2007, at 13:14:37
In reply to Re: Patient paid to accept neuroleptic depot injection, posted by med_empowered on January 5, 2007, at 19:32:28
Hello Med,
If someone tried to force me to have a Haldol depot, I would pay NOT to have it. I certainly wouldn't be interested in the offer of being paid to accept it though.......even if it was a lot of money. Thankfully, I am not in the position where anyone is trying to give me neuroleptics.
It's interesting that even some of the most ill patients with schizophrenia are well aware that their depot makes them feel worse.
Regards
Ed
Posted by ed_uk on January 6, 2007, at 13:22:54
In reply to Re: Patient paid to accept neuroleptic depot injec, posted by SLS on January 6, 2007, at 7:51:14
Hi Scott
One of the main problems with depot neuroleptics is that only a limited range of high-potency neuroleptics are available in depot form. The recent addition of Risperdal as a depot may have made treatment more tolerable for some. The side effects of high-potency depots can be severe and very prolonged. In the UK, a lot of people take daily procyclidine tablets to reduce the extrapyramidal side effects of their depot.
I know someone on Clopixol depot (zuclopentixol). Even though he has little awareness of most things (!), he does know that the depot makes him feel very restless. Given his mental state, it seems that his complaints about Clopixol have been completely ignored. This is something that worries me.
Regards
Ed
Posted by linkadge on January 6, 2007, at 13:38:33
In reply to Re: Patient paid to accept neuroleptic depot injec, posted by fca on January 6, 2007, at 12:30:59
But money can change things. Sure a person can always refuse the incentive, but say that person has a hungry family to feed, then the person might make such sacrifices.
Its like prostitution. It is outlawed because we do not think it is right that a person sell their body for money. Now, the prostitute has the decision not to sell their body, but when it comes down to it the fact that there is money in it can change a decision that somebody might not otherwise make.
Linkadge
Posted by ed_uk on January 6, 2007, at 13:39:21
In reply to Re: Patient paid to accept neuroleptic depot injec, posted by Klavot on January 6, 2007, at 12:13:29
Hi Klavot
>Where I live (South Africa), drugs like Zyprexa are not available in state hospitals because it is too expensive. They only use drugs like chlorpromazine. Even drugs like Zoloft are not used in state psychiatric facilities - they use tricyclics, because it is cheaper.
It's interesting to hear about South Africa. The UK was much slower to accept the use of atypicals than the US but things have changed a lot in recent years. Atypicals are now more widely used than typicals in the UK. Chlorpromazine and haloperidol have decreased in popularity. What you said about Zoloft was interesting. The situation in the UK is that some of the generic SSRIs are now even cheaper than the TCAs. Fluoxetine 20mg caps are the cheapest of all, the cost to the health service being about £2 per month!
Ed
Posted by ed_uk on January 6, 2007, at 13:41:41
In reply to Re: Patient paid to accept neuroleptic depot injec » fca, posted by linkadge on January 6, 2007, at 13:38:33
You make good points Link. Some patients have very valid reasons for not accepting depots.
Ed
Posted by fca on January 6, 2007, at 15:14:03
In reply to Re: Patient paid to accept neuroleptic depot injec » fca, posted by linkadge on January 6, 2007, at 13:38:33
Sure money can change things and so can no money change things--even if you believe these meds are a crap shoot regarding outcomes then they are also a crap shoot if you choose to not do it. It is essentially the same argument regarding the legalization of prostitution. Whose body is it? To assume that someone will make a bad decision because of economic vulnerability also assumes they can not or will not factor that vulnerability into their decision making. BTW, That is true of many life choices. I really do not think you can have it both ways.
Also, regarding the efficacy of antipsychotics. I have been in MH since the mid sixties and at that time worked in an institution with 4,000 plus patients. I saw the population go down to 150 in the same institution and have spent the last 30 years running Community Mental health Centers. If anyone seriously thinks that antipsychotics (new and old) have not improved the quality of life for persons with mental illness they just do not have an historical perspective. There are abuses and excesses from all perspectives and it is certain the APs are very very far from perfect. But I can assure you that stepping back 40 years there is simply no comparison regarding the quality of life for persons whether in or out of institutions. This is not a subject that one in anyway wants to romanticize the past or the present.
Posted by laima on January 6, 2007, at 15:19:33
In reply to Re: Patient paid to accept neuroleptic depot injec, posted by linkadge on January 6, 2007, at 11:08:45
...especially if they are unemployed and pretty broke. I mean, even me- if I was a touch broker than I am- it would be awfully tempting to get a zyprexa shot for a chunk of cash- and I hate the stuff! And I keep mulling over my experience with the prima-donna psychiatrist who genuinely believed that if I felt zyprexa was making me feel bizarre, it was evidence of a developing psychosis and indicated that I needed even MORE. Meanwhile, I noticed she had a zyprexa pen and notepad. One problem to be reckoned with: in some circles- unfortuneately, sometimes even in the mental health world- once one is a "mental patient"- one's credibility goes out the window. I think the term "schizophrenic" maybe even carries the ultimate in stigma. I mean, think honestly- how do would we feel about a person we meet if we were informed ahead of time, "This person coming to see you-is a schizophrenic- just so you know, just to warn you". Oh- and then such a person doesn't like their medication? What about looking into why, rather than dismissing the fact that they don't want to comply and blaming it on their mental disorder? Why not look into WHY, what the problem is. If one feels better with a med, I imagine one would look forward to it and seek it out. Perhaps some individuals are too messed up to make the connection though- I just don't know, but it definately seems possible. If someone gets involved with criminal behavior, the ethical balance shifts again for me. Ie, if someone hears instructions to hurt people, and the medication turns off those voices, then perhaps such a program is 100% valid.
I remember that last fall there was a news story about how some experts wanted to do away with the term "schizophrenia" altogether, and this was one of their reasons. I'm sure all cases are different, but the more I think about it, the more troubled I feel about this sort of program overall.
> There is also the possability that a poor patient who may have otherwise recovered from schizophrenia, would still accept injections and compromise their health, just to get the $.
>
>
> Linkadge
Posted by laima on January 6, 2007, at 15:25:33
In reply to Re: Patient paid to accept neuroleptic depot injec, posted by SLS on January 6, 2007, at 11:26:23
I've read that "schizophrenia" is so complex, it may not even be valid to to put all of the variations under one umbrella term, "schizophrenia". Causes vary, symptoms vary widely. One thing I think about is what if someone gets so stressed out that they snap? No one believes them when they describe what troubles them, treats them condescendingly and dismissively? I can imagine the shere frustration and desperation such a person must feel. Another person might slip into having symptoms due to too much drug abuse or genetics. Meanwhile, they are treated the same?? I hope doctors take such histories into account, but I never saw any such differentation discussed in my zyprexa insert. Again, I know I am extrapolating.
> Cohen:
>
> "Studies have shown that the outcome of schizophrenia is better in developing countries [10–12], and therefore the point prevalence in these countries should be lower. Despite this clear difference in the course of schizophrenia..."
>
> http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1140960#pmed-0020151-b10
>
> These statements don't make sense to me. I wonder what exactly is being diagnosed.
>
>
> - Scott
>
Posted by laima on January 6, 2007, at 15:28:24
In reply to Re: Patient paid to accept neuroleptic depot injec, posted by fca on January 6, 2007, at 12:30:59
I think desperation can be a strong factor. Waving money in front of a desperate, maybe hungry, person seems manipulative to me.
>If one is resistant to taking medication because of a fear of negative consequences why is it any less a matter of autonomy to choose compensation even if other negative consequences may be experienced. Thanks fca
Posted by laima on January 6, 2007, at 15:29:53
In reply to Re: Patient paid to accept neuroleptic depot injection » med_empowered, posted by ed_uk on January 6, 2007, at 13:14:37
Might you be tempted if you lived on the street and had no money for the homeless shelter or for food?
> Hello Med,
>
> If someone tried to force me to have a Haldol depot, I would pay NOT to have it. I certainly wouldn't be interested in the offer of being paid to accept it though.......even if it was a lot of money. Thankfully, I am not in the position where anyone is trying to give me neuroleptics.
>
> It's interesting that even some of the most ill patients with schizophrenia are well aware that their depot makes them feel worse.
>
> Regards
>
> Ed
Posted by linkadge on January 6, 2007, at 16:20:57
In reply to Re: Patient paid to accept neuroleptic depot injec, posted by fca on January 6, 2007, at 15:14:03
>If anyone seriously thinks that antipsychotics
>(new and old) have not improved the quality of >life for persons with mental illness they just >do not have an historical perspective.Well, I seriously don't think that AP's have improved the quality of life for people with schizophrenia. If they did, schizophrenics wouldn't need to be payed to take them now would they? People generally don't need to be payed to take something that improves *their* quality of life. They are, however, being payed to take something that eases the burden for society.
A quote from a good book:The Brain, Richard Restak, Based on a PBS Series, 1984
"Antischizophrenic drugs are effective in treating acute episodes of schizophrenia, but are almost useless in helping with the social withdrawl, lack of motivation, and inadeqate emotion, that are hallmarks of the disorder"
Getting people out of an institution is only one step, all it is saying is that patients are now more managable. Perhaps they can eat and sleep now at their own. It says nothing of their quality of life.
And again, AP's can do some significant things in a short period of time, but what are they doing in the long run.
Its like like antidepressants. Sure one could argue 10 years ago that they save lives, but now they are pooping out left and right, and you've got a whole slew of people back to square one. Actually they are worse than square one, because now they are addicted to drugs that do little or nothing.
Linkadge
Posted by linkadge on January 6, 2007, at 16:26:37
In reply to Re: Patient paid to accept neuroleptic depot injection, posted by laima on January 6, 2007, at 15:29:53
>And I keep mulling over my experience with the >prima-donna psychiatrist who genuinely believed >that if I felt zyprexa was making me feel >bizarre, it was evidence of a developing >psychosis and indicated that I needed even MORE. >Meanwhile, I noticed she had a zyprexa pen and >notepad.
Wow, thats intense. I can see the Lilly representitive trying to explain that one. "Well sometimes people on Zyprexa claim that the drug makes them feel wierd, this is a sign that the individual is indeed psychotic, and needs more medication".
"Might you be tempted if you lived on the street and had no money for the homeless shelter or for food?"
Exactly, then you're homless, and you're on potent antipsychotics, not a good combination. Nothing peps up an interview like Haldol.
Linkadge
Posted by med_empowered on January 6, 2007, at 16:47:35
In reply to Re: Patient paid to accept neuroleptic depot injection, posted by linkadge on January 6, 2007, at 16:26:37
I think neuroleptics are pretty bad drugs. I read somewhere (maybe david healy?) that if neuroleptics hadn't yet been invented by now, there would be no need to invent them. The drugs "aren't perfect" because the side effects (movement disorders, sedation, lethary, akathisia, dysphoria, cognitive impairment) are simply a part of the main action. These aren't unintended or preventable side effects--this is what happens when you consistently block 60% or more of someone's d2 receptors. Also, I fail to see how numbing someone up for years and years is "therapeutic".
I'll be honest--sometimes, when I was freaking out, a low-dose atypical helped. It didn't save me, but it helped. But that's very low-dose,and very short-term. We're talking about keeping people on these drugs indefinitely, even though the side effects of the old ones are known, and the side effects of the atypicals are beginning to appear similar to the old ones (plus the fine side effects of massive weight gain and diabetes. woo hoo!)
Also, it strikes me as odd that (in the US at least) minorities (especially african americans) and poor people are more likely to receive a DX of "schizophrenia" than are white or non-poor patients with similar symptoms. Also, even though African Americans are often "poor metabolizers" of neuroleptics and therefore should be given less, they are often prescribed stronger neuroleptics in higher dosages for longer periods of time. Not surprisingly, African American psychiatric patients are more likely than their white counterparts to suffer from tardive dyskinesia. "Schizophrenia" is a label that can easily be used to discredit and dismiss someone, especially if that someone is poor and/or non-white. Neuroleptics are a great way to imprison people's minds when the law won't let you imprison their bodies (which, considering the huge prison population in the US, isn't all that hard to do, either).
Posted by ed_uk on January 6, 2007, at 16:51:32
In reply to Re: Patient paid to accept neuroleptic depot injection, posted by laima on January 6, 2007, at 15:29:53
>Might you be tempted if you lived on the street and had no money for the homeless shelter or for food?
No! I've taken APs before (as tablets) and they made me feel so incredibly awful I would do anything to avoid them!
Ed
Posted by fca on January 6, 2007, at 17:03:18
In reply to Re: Patient paid to accept neuroleptic depot injec, posted by linkadge on January 6, 2007, at 16:20:57
I have spent thousands of hours with 100s and 100s of persons with schizophrenia over the last 40 years. The progress is nothing less than remarkable in terms of their ability to live independently, maintain meaningful personal relationships, work, etc. And this is due primarily to improvements in APs. I would encourage you to spend time (and I do not mean 2 hours or a 10 day visit) but real time with persons at different points in their recovery(or stabilization) from schizophrenia. Of course a number do not want to take medicine--it has side crappy effects, sometimes it does not work and the illness itself causes mistrust and noncompliance. I am sorry for the strength of my response but I am constantly amazed and gratified by the progress that has been made. Schizophrenia is a devastating illness and I saw it when the meds were primitive and people led terribly compromised lives both inside and out of hospitals . Of course it easier for society if people are med compliant--it's also better for society if people were not addicted to alcohol and drugs. But in both cases the ultimate victims are the sufferers themselves. Finally, there is so much physical evidence (CAT scans, MRIs, PETs)that each major decompensation is a physical assault on the brain that minimizing the intensity and length of the acute decompensation is very important. Meds, while not preventing decompensation, due mitigate the damage done. Thanks for your patience fca
Posted by fca on January 6, 2007, at 17:18:22
In reply to Re: Patient paid to accept neuroleptic depot injec, posted by med_empowered on January 6, 2007, at 16:47:35
Numbing up, TD, cognitive impairment and other side effects (not universal especially if carefully monitored)are miserable and probably are a form of prison. Please take time to seriously think about the alternatives--florid hallucinations, devastating delusions, self mutilation, total social isolation etc are not particularly desirable. I spent a lot of time with people with schizophrenia when drugs were brand new--a ward with 30 active delusional and or hallucinating patients is bedlam and not comforting for anyone--particularly the patients. TD is awful, and I mean awful--but I ask you to compare it to what persons experienced before the APs. ECTs that did not work, insulin therapy which did not work, rapid progressive organic brain damage, hours/days in isolation rooms. One can say that we should have spent enough so the institutions were humane and sensitive. Couldn't happen and wouldn't happen. Set aside politics and limited resources there is noting humane or caring about living with florid schizophrenia. You have to be tired of an old man's ranting.. Thanks Again
Posted by SLS on January 6, 2007, at 17:51:40
In reply to Re: Patient paid to accept neuroleptic depot injec » SLS, posted by ed_uk on January 6, 2007, at 13:22:54
Hi Ed.
> I know someone on Clopixol depot (zuclopentixol). Even though he has little awareness of most things (!),Can you be more specific in your description? Is it your guess that this is the result of the illness or of a neuroleptic-facilitated cognitive deficit?
> he does know that the depot makes him feel very restless. Given his mental state, it seems that his complaints about Clopixol have been completely ignored.
Is this the fault of the drug or the doctor?
Just as people have untoward reactions to antidepressants that are wrong for them, so, too, can this be said of neuroleptics.
Lots of drugs suck. I wasn't too happy with Prolixin when I was injected with it. Zyprexa, on the other hand, was wonderful as an anti-manic. It resolved the mania and cleared up my thinking. I was far from being a walking zombie. You could pay me to take a neuroleptic. In fact, I would appreciate it if you would pay for my next refill of Abilify.
> This is something that worries me.
Generalizations worry me.
- Scott
Posted by SLS on January 6, 2007, at 18:00:43
In reply to Re: Patient paid to accept neuroleptic depot injec, posted by fca on January 6, 2007, at 17:03:18
> I have spent thousands of hours with 100s and 100s of persons with schizophrenia over the last 40 years. The progress is nothing less than remarkable in terms of their ability to live independently, maintain meaningful personal relationships, work, etc. And this is due primarily to improvements in APs.
This has been my observation as well.
> Finally, there is so much physical evidence (CAT scans, MRIs, PETs)that each major decompensation is a physical assault on the brain that minimizing the intensity and length of the acute decompensation is very important.
Yes. The schizophrenic episode itself is neurotoxic.
- Scott
Posted by linkadge on January 6, 2007, at 18:13:06
In reply to Re: Patient paid to accept neuroleptic depot injec, posted by fca on January 6, 2007, at 17:03:18
>And this is due primarily to improvements in APs.
I don't think there is conclusive evidence that atypical antipsychotics are any more effective, have fewer side effects, or are better at treating negative symtpoms as compared to conventional AP's.
A number of large studies have found no clear advantage of atypicals over conventional AP's. For instance, this study of 12,640 patients found no evidence of superiority.
http://www.bmj.com/cgi/content/full/321/7273/1371
>I am sorry for the strength of my response but I >am constantly amazed and gratified by the >progress that has been made.I don't know what progress has been made. The atypicals may be slightly more tollerable, but do not have proven superiority. They are also more likely to cause metabolic problems, which might not show up in the short term. Atypicals have not been around long enough to know the true indidence of TD. So, you are really just trading side effects.
A good percentage of patients quit their medications and lie about compliance. When I was in the hospital, for instance, I "cheeked", my seroquel, then spat it down the drain. I lied about improvement, and faked a reduction in symptoms just so I could get out. If I can do it, so can others.
>Meds, while not preventing decompensation, due >mitigate the damage done.
Do you have any references for this? For instance, there was some intial speculation that antidepressants reduced the damamge done by depressive episodes, but new evidence suggests there is no such protective effect. In a number of studies, antidepressants exaserbate the effects of stress on hippocampal morphology.
AP's can induce cumulative exposure damamge, perhaps through an increase in oxidative stress. It is thought that TD is a result of oxidative stress. People with schizophrenia are already known to have decreased antioxidant defenses and may be even more susceptable to such dammage.
Cognitive deficits induced by antipsychotics are not just due to monoamine disrupting effects. They may too be a result of increased oxidative stress.
Pathological changes in the postmortem brain of schizophrenics also have been reported in the medical literature, from exposure to antipsychotics, as compared no nonexposue. Unbiased, healthy animal studies also show brain morphology dependant on exposure duration. Many antipsychotics also downregulate BDNF, a molecule critical for the survival, growth and maintainance of new brain cells.
A quote from:
http://www.hdlighthouse.org/treatment-care/treatment/drugs/related/updates/0061risperidone.php
Dr. Sahebarao P. Mahadik (left) and Dr. Alvin V. Terry Jr. University of Georgia and the Medical College of Georgia.
"You give them a dose of haloperidol, you study receptors in their brain, you see that they block dopamine receptors so they don't have as many psychotic outbursts. Patients are quiet, docile and more easily managed … but their cognition becomes impaired, and it's worse than it would have been without treatment."
Another study:
Costly Schizophrenia Drugs No Better Than Older Generic:
http://health.dailynewscentral.com/content/view/1654/63
Also, taken from:
http://www.bmj.com/cgi/content/full/329/7474/1058
However, recent critiques have shown that recovery and readmission rates in schizophrenia before 1950 were no different7 and that antipsychotic agents might even do more harm than good.8 Thus the marked decline in the numbers of patients in asylums, from the mid-1950s (in the United Kingdom from some 150 000 in 1956 to under 40 000 in 1990) is usually attributed, at least in part, to effects of the medication. But this decline could equally be seen as socially generated via fiscal policies and community care programmes.8 Enhanced biological vulnerability to psychotic relapse might even be a result of the brain being made supersensitive to dopamine,9 medication thus acting as a double edged sword, relieving the symptoms of illness but creating an increased potential for relapse once drugs are discontinued.
Linkadge
Posted by med_empowered on January 6, 2007, at 18:25:42
In reply to Re: Patient paid to accept neuroleptic depot injec, posted by linkadge on January 6, 2007, at 18:13:06
I seem to recall seeing studies from as early as the laste 50s and early 60s (back when "antipsychotics" were being called "ataractic" drugs") that showed, even then, that the drugs weren't helpful.
I'm not anti-drug per se, but I do think we have to be careful about the drugs we go around spraying people with. Antipsychotics have a pretty long history of causing bad side effects. I can see how giving someone who is psychotic a neuroleptic, especially if you conceive of acute schizophrenic psychosis as a psychosis-heavy form of Bipolar Mania, as some have suggested. Do it short term, minimize discomfort, stop the episode, prevent too much long term damage from their actions. But months and years of this stuff? It seems ill advised. Very, very ill advised.
If someone must be medicated in schizophrenia (and a lot of people seem to do fine, over time, w/o meds), there are other meds. Try the anticonvulsants. Use benzos. Maybe even give good 'ole placebo a whirl. Opiates may be effective. But neuroleptics? To say that the "only" drugs effective for schizophrenia have "unfortunate side effects" is inaccurate. There are other meds to use--they may not be specifically "antipsychotic," but there are indications that they work on some symptoms in a good number of patients. I think the problem isn't trying to medicate some of the symptoms of schizophrenia, at least for a while--that can actually give patients and families a needed break from active psychosis--I think the problem is that the meds being used (D2 blockers) tend to be unpleasant and carry unpleasant and unwanted side effects.
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